Please provide the following contact information:
First Name* ex. John Last Name* ex. Smith Street Address* ex. 121 Main St. Address (cont.) ex. put extended address here City* ex. Some Town State/Province* ex. Mi or MICH or Michigan Zip/Postal Code* ex. 12345 Home Phone* ex. 2485551212 E-mail* ex. Johnsmith@hotmail.com Birthday* Choose Month January February March April May June July August September October November December Select Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ex. Select month and day from drop down boxes. Membership Due Payment Option* Select One I will mail in a check to the Motor City Bear PO Box. I will pay cash/check at the next meeting/event. I will send payment via PayPal. I will email treasurer@motorcitybears.com with my membership payment options. I have already paid my dues to the Treasurer. Select One NO Yes * Roster Opt Out: Select "YES" here if you do not want to be included in the roster, however, you will not receive a roster or any club mailings. Select One > Select One Yes * By checking this box, I hereby signify that I am at least 21 years of age or older. Signature* ex. John Smith, making sure you clear "Type your name" Typing in your name and submitting your information signifies that all information is true and accurate. * These are required fields, failure to do so will result in a Front Page Error Page and the information will be lost and you must re-enter all information again. If you do not get a confirmation email with in 5 days, please email the officers@motorcitybears.com.
Typing in your name and submitting your information signifies that all information is true and accurate.
